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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846030
Report Date: 10/22/2021
Date Signed: 10/26/2021 10:38:18 AM

Document Has Been Signed on 10/26/2021 10:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JUST 4 KIDS PRESCHOOL-CORONAFACILITY NUMBER:
334846030
ADMINISTRATOR:GARCIA, VERONICAFACILITY TYPE:
830
ADDRESS:1585 E ONTARIO AVETELEPHONE:
(951) 479-3888
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 6DATE:
10/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:43 PM
MET WITH:Veronica GarciaTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Kim Leung conducted a case management visit at the facility this date on 10/22/2021 in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 10/20/2021. It indicates that on 10/14/2021, a child fell to the floor and hit the head after being pushed by another child. It was reported that the child who fell started seizing and was transported to the hospital by paramedic.

Upon arrival, LPA met with facility director Veronica Garcia and stated the purpose of the visit. Facility records were reviewed and interviews were conducted. LPA obtained information that the incident occurred between 4:30pm and 5pm on 10/14/2021 after the infant class and the toddler class were combined. LPA obtained information that there were one teacher and one assistant teacher supervising 7 children at time of the incident. LPA obtained information that Child 1 and Child 2 had both entered the crib area and staff observed Child 2 pushing one of the cribs towards Child 1. Staff stated that when they intervened, Child 2 pushed Child 1 on the shoulder causing Child 1 fell backward hitting the back of the head against the vinyl floor. LPA obtained information that staff attended to Child 1 immediately. Staff stated that they observed foam coming out of Child 1's mouth and the child's skin started to turn blue. Staff stated that Child 1 appeared not responsive right after the fall. Director was notified and 911 was called. Staff stated that they followed 911 dispatcher's instructions to keep the child awake prior to the arrival of paramedic. Staff stated that paramedic arrived within 5 minutes and transported the child to the hospital. The child's mother was accompanying the child to the hospital. LPA obtained information that Child 1 was diagnosed a delayed concussion with no further brain damage.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JUST 4 KIDS PRESCHOOL-CORONA
FACILITY NUMBER: 334846030
VISIT DATE: 10/22/2021
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During the inspection, LPA toured the infant room and the crib area. Director stated that they were in the process of installing a gate to prevent children walking in and out the crib area during activity time.

Facility took appropriate actions to attend to Child 1 and called 911 in a timely manner after the occurrence of the fall. No deficiency was cited at this time.

An exit interview was conducted with director Veronica Garcia. A Notice of Site visit was issued and must be posted for 30 days.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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